scholarly journals Making Emergency Care in Rural Areas Fit for Future: Protocol for multi-method and multi-perspective longitudinal analysis and control group study (Preprint)

2019 ◽  
Author(s):  
Camilla Metelmann ◽  
Bibiana Metelmann ◽  
Dorothea Kohnen ◽  
Clara Prasser ◽  
Rebekka Süss ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Care ◽  
Rural Areas ◽  
Statutory Health Insurance ◽  
First Aid ◽  
Medical Services ◽  
Emergency Medical Care ◽  
Free Interval ◽  
Emergency Medical

BACKGROUND The German Emergency Medical Services is a two-tiered system with paramedic staffed ambulances as primary response supported by pre-hospital emergency doctors for life-threatening conditions. As in all European health care systems, German medical practitioners are in short supply whilst the demand for timely emergency medical care is constantly growing. In rural areas, this has led to critical delays in the provision of emergency medical care. In particular, in cases of cardiac arrest, time is of essence [1], because with each minute passing, the chance of survival with good neurological outcome decreases. OBJECTIVE The project follows four main objectives: 1) Reducing the therapy-free interval through widespread reinforcement of resuscitation skills and motivating the public to provide help (called bystander-CPR), (2) fast, professional first aid in addition to rescue services through alarming trained first aiders via smartphone, (3) faster and higher availability of emergency physicians through introducing the tele-emergency physician (TEP) system, and (4) enhanced emergency care through improving the cooperation between statutory health insurance on-call medical services (German: Kassenärztlicher Bereitschaftsdienst) and emergency medical services. METHODS The implementation of the project is evaluated through a tripartite prospective and intervention study: (1) in medical evaluation, the influences of various project measures on quality of care are assessed using multiple methods. (2) The economic evaluation mainly focuses on the valuation of inputs and outcomes of the different measures while considering various relevant indicators. (3) As part of the scientific work and organizational evaluation important work- and occupational-related parameters but also network and regional indexes are assessed. RESULTS The project was started in 2017 and enrollment will be completed in 2020. The pre-analysis phase recently finished. CONCLUSIONS Overall, the implementation of the project entails the realignment of emergency medicine in rural areas and the enhancement of quality of medical emergency care in the long-term. It is expected to lead to a measurable increase in medical laypersons’ individual motivation to provide resuscitation, to strengthen resuscitation skills as well as much more frequently provided first aid through medical laypersons. Furthermore, the project is intended to decrease the therapy-free interval in cases of cardiac arrest by dispatching first aiders via smartphones. As demonstrated by previous projects in urban regions, the TEP system has already proven a higher availability and quality of emergency call-outs in regular health care. A closer interrelation of emergency practices of statutory health insurance physicians with the rescue service is expected to lead to a better coordination of rescue and on-call services. CLINICALTRIAL Ethikkomission (ethics comission) an der Universität Greifswald BB 111/17 http://www2.medizin.uni-greifswald.de/ethik/

scholarly journals Evaluation of a Rural Emergency Medical Service Project in Germany: Protocol for a Multimethod and Multiperspective Longitudinal Analysis

10.2196/14358 ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. e14358 ◽  
Author(s):  
Camilla Metelmann ◽  
Bibiana Metelmann ◽  
Dorothea Kohnen ◽  
Clara Prasser ◽  
Rebekka Süss ◽  
...  
Keyword(s):  
Health Care ◽  
Cardiac Arrest ◽  
Rural Areas ◽  
Statutory Health Insurance ◽  
First Aid ◽  
Medical Services ◽  
Emergency Medical Care ◽  
Free Interval ◽  
Emergency Medical

Background German emergency medical services are a 2-tiered system with paramedic-staffed ambulances as the primary response, supported by prehospital emergency doctors for life-threatening conditions. As in all European health care systems, German medical practitioners are in short supply, whereas the demand for timely emergency medical care is constantly growing. In rural areas, this has led to critical delays in the provision of emergency medical care. In particular, in cases of cardiac arrest, time is of the essence because, with each passing minute, the chance of survival with good neurological outcome decreases. Objective The project has 4 main objectives: (1) reduce the therapy-free interval through widespread reinforcement of resuscitation skills and motivating the public to provide help (ie, bystander cardiopulmonary resuscitation), (2) provide faster professional first aid in addition to rescue services through alerting trained first aiders by mobile phone, (3) make more emergency physicians available more quickly through introducing the tele-emergency physician system, and (4) enhance emergency care through improving the cooperation between statutory health insurance on-call medical services (German: Kassenärztlicher Bereitschaftsdienst) and emergency medical services. Methods We will evaluate project implementation in a tripartite prospective and intervention study. First, in medical evaluation, we will assess the influences of various project measures on quality of care using multiple methods. Second, the economic evaluation will mainly focus on the valuation of inputs and outcomes of the different measures while considering various relevant indicators. Third, as part of the work and organizational analysis, we will assess important work- and occupational-related parameters, as well as network and regional indexes. Results We started the project in 2017 and will complete enrollment in 2020. We finished the preanalysis phase in September 2018. Conclusions Overall, implementation of the project will entail realigning emergency medicine in rural areas and enhancing the quality of medical emergency care in the long term. We expect the project to lead to a measurable increase in medical laypersons’ individual motivation to provide resuscitation, to strengthen resuscitation skills, and to result in medical laypersons providing first aid much more frequently. Furthermore, we intend the project to decrease the therapy-free interval in cases of cardiac arrest by dispatching first aiders via mobile phones. Previous projects in urban regions have shown that the tele-emergency physician system can provide a higher availability and quality of emergency call-outs in regular health care. We expect a closer interrelation of emergency practices of statutory health insurance physicians with the rescue service to lead to better coordination of rescue and on-call services. International Registered Report Identifier (IRRID) DERR1-10.2196/14358

Quality of services of emergency medical care in terms of health care reform

2016 ◽  
Vol 10 (4) ◽  
pp. 102-111
Author(s):  
Алексей Белобородов ◽  
Aleksey Beloborodov ◽  
Елена Данилина ◽  
Elena Danilina ◽  
Екатерина Яковлева ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Performance Indicators ◽  
Structural Model ◽  
Medical Services ◽  
Emergency Medical Care ◽  
Emergency Medical ◽  
And Performance ◽  
Definition Of

The article deals with the question of quality assurance of emergency medical care. It is of vital importance in terms of reforming the system of healthcare in the Russian Federation, as the quality and availability of various types of medical services are priority indicators of reform. Quality ensuring of emergency medical care is the most important socially significant task of health care, which lies in maintaining the health of people in extreme conditions and in meeting the challenges of mortality reduction. This is resulted in increased attention to research in this area. Quality ensuring of emergency medical services actualizes the task of improving of its assessment methodology. The methodological problems of services quality assessment in the system of emergency medical care limiting applied research are the subject of the study. The structure of emergency medical care is specified, the separation of concepts of "medical service" and "medical care" of services of emergency medical care is accomplished, and the concept of "medical care" is defined in the article. Based on the results of market research of patients’ satisfaction with quality of medical care in emergency hospital of Krasnoyarsk a structural model of services of emergency medical care has been created. This model reflects the patients’ understanding that the quality of service of emergency medical care is an integrated category, combining the quality of the result of medical services and quality of care. Content analysis of the definition of basic concepts in the field of quality of health care has allowed to formulate the concept of "service quality of emergency medical care”. Its difference is that the definition includes goal-setting of quality of emergency medical care as ensuring the effective medical care, as well as performance indicators of emergency medical care are formulated. The proposed concept and performance indicators of emergency medical care stimulate new directions for research in this area.

Guidelines for Pediatric Emergency Care Facilities

PEDIATRICS ◽  
1995 ◽  
Vol 96 (3) ◽  
pp. 526-537
Author(s):  
Keyword(s):  
Health Care ◽  
Emergency Medical Services ◽  
Emergency Care ◽  
Pediatric Emergency ◽  
Medical Services ◽  
Emergency Medical ◽  
Care Facilities ◽  
Trained Personnel ◽  
Pediatric Emergency Care

Emergency care for life-threatening pediatric illness and injury requires specialized resources including equipment, drugs, trained personnel, and facilities. The American Medical Association Commission on Emergency Medical Services has provided guidelines for the categorization of hospital pediatric emergency facilities that have been endorsed by the American Academy of Pediatrics (AAP).1 This document was used as the basis for these revised guidelines, which define: 1. The desirable characteristics of a system of Emergency Medical Services for Children (EMSC) that may help achieve a reduction in mortality and morbidity, including long-term disability. 2. The role of health care facilities in identifying and organizing the resources necessary to provide the best possible pediatric emergency care within a region. 3. An integrated system of facilities that provides timely access and appropriate levels of care for all critically ill or injured children. 4. The responsibility of the health cane facility for support of medical control of pre-hospital activities and the pediatric emergency care and education of pre-hospital providers, nurses, and physicians. 5. The role of pediatric centers in providing outreach education and consultation to community facilities. 6. The role of health cane facilities for maintaining communication with the medical home of the patient. Children have their emergency care needs met in a variety of settings, from small community hospitals to large medical centers. Resources available to these health care sites vary, and they may not always have the necessary equipment, supplies, and trained personnel required to meet the special needs of pediatric patients during emergency situations.

scholarly journals Evaluation of the Quality of Medical Care to the Population at the Level of Day Stations and Emergency Stations

2022 ◽  
Vol 8 (1) ◽  
pp. 114-121
Author(s):  
B. Niyazov ◽  
S. Niyazovа
Keyword(s):  
Medical Care ◽  
Emergency Medical Services ◽  
Chronic Diseases ◽  
Emergency Care ◽  
Rural Population ◽  
Medical Services ◽  
Emergency Medical ◽  
Medical Institutions ◽  
Quality Of Medical Care

Insufficient availability of emergency medical services to the rural population is noted. The dynamics of the growth of calls to emergency medical services testifies to the fact that emergency medical institutions have taken over part of inpatient services for the provision of emergency care to patients with chronic diseases and acute colds.

Zufriedenheit mit der Gesundheitsversorgung: Gibt es strukturelle Unterschiede?

2018 ◽  
Vol 67 (3) ◽  
pp. 288-307
Author(s):  
Katharina Lima de Miranda ◽  
Daniel Prosi ◽  
Ulrich Schmidt ◽  
Hanna Wecker
Keyword(s):  
Health Care ◽  
Rural Areas ◽  
Statutory Health Insurance ◽  
Waiting Times ◽  
Private Insurance ◽  
Public And Private ◽  
Structural Differences ◽  
Urban And Rural Areas ◽  
Care Costs

Abstract This study examines structural differences in the subjective quality of health care in Germany using a newspaper survey. We find that there are significant differences between urban and rural areas as well as between public and private insurance. In rural areas, the provision of general practitioners, specialists and hospitals are considered as worse than in cities. In particular, public insured individuals asses the provision of specialized doctors and hospitals as lower than private insured and criticize long waiting times for appointments and lacking coverage of health care costs by the statutory health insurance.

scholarly journals “Dying due to poverty and lack of easy transport”: A qualitative study on access and availability of pre-hospital emergency medical services in Kampala, Uganda

2019 ◽  
Author(s):  
Amber Mehmood ◽  
Shirin Wadhwaniya ◽  
Esther Bayiga Zziwa ◽  
Olive C Kobusingye
Keyword(s):  
Qualitative Study ◽  
Emergency Medical Services ◽  
Emergency Care ◽  
Poor Quality ◽  
Medical Services ◽  
Community Members ◽  
Hospital Emergency ◽  
Care Services ◽  
Emergency Medical

Abstract Background Emergency care services in low-and middle-income countries (LMICs) have traditionally received less attention in the dominant culture favouring vertical health programs. The unmet needs of pre-hospital and hospital-based emergency services are high but the barriers to accessing safe and quality emergency medical services (EMS) remain largely unaddressed. Few studies in Sub-Saharan Africa have qualitatively investigated barriers to EMS use, and quality of pre-hospital services from the providers and community perspective. We conducted a qualitative study to describe the patient-centred approach to emergency care in Kampala, Uganda, with specific attention to access to EMS.Methods The data collection was comprised of Key Informant Interviews (KII) and Focus Group Discussions (FGDs) with the community members. KII participants were selected using maximum purposive sampling based on expert knowledge of emergency care systems, and service delivery. FGDs were conducted to understand perceptions and experiences towards access to pre-hospital care, and to explore barriers to utilization of EMS. The respondents of ten KII and seven FGDs included pre-hospital EMS (PEMS) administrators, policy makers, police, health workers and community members. We conducted a directed content analysis to identify key themes and triangulate findings across different informant groups.Results Key themes emerged across interviews and discussions concerning: (1) lack of funds, (2) lack of standards, (3) need for upfront payments for emergency transport and care, 4) corruption, 5) poor quality pre-hospital emergency service, 6) poor quality hospital emergency care, and 7) delay in seeking treatment.Conclusions Patient-centred emergency care should be an integral part of comprehensive health care services. As Uganda and other LMICs continue to strive for universal health coverage, it is critical to prioritize and integrate emergency care within health systems owing to its cross-cutting nature. Community perceptions around access and quality of PEMS should be addressed in national policies covering affordable and safe EMS.

scholarly journals An online emergency medical management information system using mobile computing

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Sarandis Mitropoulos ◽  
Christos Mitsis ◽  
Petros Valacheas ◽  
Christos Douligeris
Keyword(s):  
Health Care ◽  
Information System ◽  
Health Services ◽  
Literature Review ◽  
Human Resources ◽  
Emergency Care ◽  
Content Type ◽  
Emergency Medical ◽  
Care System

PurposeThe purpose of this paper is to investigate the way technology affects the provision of prehospital emergency care, upgrading the quality of services offered and significantly reducing the risk of premature termination of the patients.Design/methodology/approachThe paper presents the development of the eEKAB, a pilot emergency medical information system that simulates the main services offered by the Greek National Instant Aid Centre (EKAB). The eEKAB was developed on an agile system methodology. From a technical perspective, the features and the technology were mainly chosen to provide reliable and user-friendly interfaces that will attract many users. eEKAB is based on three important pillars for offering health care to the patients: the “On-time Incident Reporting”, the “On-time Arrival at the Incident” and “Transfer to the Health Center”. According to the literature review, the emergency medical services (EMS) systems that combine all the features are very few.FindingsIt reduces the total time of the EMS procedures and it allows for an easier management of EMS, by providing a better allocation of human resources and a better geographical distribution of ambulances. The evaluation displayed that it is a very helpful application for the ambulance drivers as it reduces the ambulance response time to arrive in the patient's location and contributes significantly to the general performance of the prehospital medical care system. Also, the survey verified the importance of implementing eEKAB on a larger scale beyond the pilot usage. It is worth mentioning that the younger ambulance drivers had a more positive view for the purpose of the application.Research limitations/implicationsThe paper clearly identifies implications for further research. Regarding interoperability, the mobile app cooperates with the Operational Center of EKAB, while further collaboration could be achieved with other operational ambulance handling center, mainly, of the private sector. The system can evolve to include better communications among the EKAB departments. Particularly, the ambulance crew as well as the doctors should be informed with more incident features such as the emergency signal so that they know whether to open the siren, the patient's name, etc. The authors are currently working on implementing some features to provide effective medical health services to the patient in the ambulance.Practical implicationseEKAB will have very significant implications in case of its enforcement, such as the reduction of the total time of EMS procedures with a corresponding reduction of the operating costs of an accident management system and an ambulance fleet handling system while in parallel informing in time the doctors/clinics. It will provide better distribution of ambulances as well as of total human resources. It will greatly assist ambulance drivers, while reducing ambulance response time to reach the patient's location. In other words, the authors will have a better performance of the whole prehospital care system.Social implicationsProviding emergency care before the hospital is of great importance for upgrading the quality of health services provided at the accident site, thus significantly reducing the risk of premature death of patients. This in itself has a significant social implication.Originality/valueThe paper demonstrates a solid understanding in the field of the EMS systems and the corresponding medical services offered. It proposes the development of an effective, feasible and innovative EMS information system that will improve the existing emergency health care system in Greece (EKAB). An in depth literature review and presentation of the adopted new technologies and the respective architecture take place. An evaluation and statistical validation were conducted for proving the high applicability of eEKAB in case of real-life running.

Apart from the Medical Complaints, Why do Patients Use Emergency Medical Services? Results of a Patient Survey

2021 ◽  
Author(s):  
Silke Piedmont ◽  
Anna Katharina Reinhold ◽  
Jens-Oliver Bock ◽  
Janett Rothhardt ◽  
Enno Swart ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Medical Services ◽  
Emergency Care ◽  
Logistic Models ◽  
Patient Survey ◽  
Insurance Companies ◽  
Medical Services ◽  
Prehospital Emergency Care ◽  
Care Providers ◽  
Emergency Medical

Abstract Introduction Many countries face an increased use of emergency medical services (EMS) with a decreasing percentage of life-threatening complaints. Though there is a broad discussion among experts about the cause, patients' self-perceived, non-medical reasons for using EMS remain largely unknown. Methods The written survey included EMS patients who had≥1 case of prehospital emergency care in 2016. Four German health insurance companies sent out postal questionnaires to 1312 insured patients. The response rate was 20%; 254 questionnaires were eligible for descriptive and interferential analyses (t-tests, chi2-tests, logistic models). Results The majority of respondents indicated that their EMS use was due to an emergency or someone else’s decision (≥84%; multiple checks allowed); 56% gave need for a quick transport as a reason. Other frequently stated reasons addressed the health care system (e. g., complaints outside of physicians’ opening hours) and insecurity/anxiety about one’s state of health (>45% of the respondents). “Social factors” were similarly important (e. g., 42% affirming, “No one could give me a ride to the emergency department or doctor’s office.”). Every fifth person had contact with other emergency care providers prior to EMS use. Respondents negating an emergency as a reason were less likely to confirm wanting immediate medical care on site or quick transports compared to those affirming an emergency. Patients using EMS at night more often denied having an emergency compared to patients with access to care during the day. Conclusion The study identified a bundle of reasons leading to EMS use apart from medical complaints. Attempts for needs-oriented EMS use should essentially include optimization of the health care and social support system and measures to reduce patients’ insecurity.

THE QUALITY OF MEDICAL CARE IN MEDICAL ORGANIZATIONS OF MOSCOW PUBLIC HEALTH CARE SYSTEM IN APPRAISALS OF PATIENTS AND PHYSICIANS

2017 ◽  
Vol 16 (2) ◽  
pp. 100-106 ◽  
Author(s):  
I. Ya Tadjiev ◽  
A. V Belostotsky ◽  
S. S Budarin
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Medical Personnel ◽  
Public Health Care ◽  
Fee For Service ◽  
Emergency Medical Care ◽  
Emergency Medical ◽  
Quality Of Medical Care ◽  
High Level

The article presents the analysis of results of complex medical sociological survey of effectiveness and efficiency of medical care as main criteria of its quality and accessibility. The survey comprised 1,737 patients of various social groups of population of Moscow and 203 physicians of polyclinics. At self-rating of health, 13.2% of respondents determined it as unsatisfactory, 45.1% as satisfactory and 31.3% as good. In all population groups, the most called-for proved to be polyclinic institutions. The high level of satisfaction of patients with quality of emergency medical care was established in all groups. The quality of medical care in polyclinics and hospitals was assessed significantly lower. The most negatively assessed criteria turned out transition to fee-for-service forms of medical support and time limits of waiting for all modes of medical care, except emergency medical care and district therapist. The evaluation by physicians of their own activity and present problems is characterized by their unanimity in need of increasing of salary (100%) and increasing of typical sectoral standards of time of reception of a patient (96.5%), decreasing of intensity of work of medical personal (92.3%) and reduction of some forms of record cards with the purpose of releasing of time and attention of physician for a patient (88.4%). The disrespectful attitude of patients to medical personnel was mentioned by 77.3% of physicians which is a new phenomenon testifying loss of confidence in patient-physician relationship. The quality of implemented work was assessed equally and rather high by both young and experienced physicians. The positive and negative aspects of reorganization of health care were analyzed. Two alternatives of problems were established to focus plans of development of system of Moscow health care to support accessible and qualitative medical care of population.

The emergency medical system

2015 ◽  
Author(s):  
Marc Sabbe ◽  
K Bronselaer ◽  
O Hoogmartens
Keyword(s):  
Medical Care ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Emergency Medical Care ◽  
Hospital Emergency ◽  
High Quality Research ◽  
Emergency Medical ◽  
System P ◽  
Quality Of Medical Care

The mission of the emergency medical services is to promote and support a system that provides timely, professional, and state-of-the art emergency medical care, including ambulance services, to anyone who is victim of a sudden injury or illness, at any time or location and at any phase of the emergency incident. These phases include lay people’s prevention and preparedness, occurrence of the problem, its detection, alarming of trained responders, help provided by bystanders and trained pre-hospital providers, transport to the appropriate hospital, and, if necessary, admission or transfer to a more appropriate hospital. In order to meet the goal outlined, emergency medical services must work closely with local and state officials—fire and rescue departments, other ambulance providers, hospitals, and other agencies—to foster a smooth functioning network. The term emergency medical services evolved to reflect a change from a simple system of ambulances, providing only transportation, to a system in which actual medical care is given at the scene and during transport. Medical supervision and/or participation of emergency medicine physicians in the emergency medical services systems contribute to the quality of medical care. This emergency medical services network must be capable of responding instantly and reliably around the clock, with well-trained, well-equipped personnel linked, as needed, through a strong communication system. Research plays an important role in conserving resources and improving the delivery of health care. This chapter gives an overview of the different aspects of emergency medical services and calls for high-quality research in pre-hospital emergency care in a true partnership between cardiologists and emergency physicians.

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